TY - JOUR

T1 - Patient-Specific Implantation Technique to Obtain Neo-Commissural Alignment With Self-Expanding Transcatheter Aortic Valves

AU - Bieliauskas, Gintautas

AU - Wong, Ivan

AU - Bajoras, Vilhelmas

AU - Wang, Xi

AU - Kofoed, Klaus Fuglsang

AU - De Backer, Ole

AU - Søndergaard, Lars

N1 - Funding Information: Dr Bieliauskas has received consulting fees from Abbott, Boston Scientific, and Medtronic. Dr Kofoed has received institutional grants from AP Møller og hustru Chastine McKinney Møllers Fond, The Meyer Foundation, The Danish Heart Foundation, The Danish Agency for Science, Technology and Innovation by The Danish Council for Strategic Research and Canon Medical Corporation. Dr De Backer has received institutional research grants and consulting fees from Abbott and Boston Scientific. Dr Søndergaard has received institutional research grants and consulting fees from Abbott, Boston Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2021 American College of Cardiology Foundation

PY - 2021

Y1 - 2021

N2 - Objectives: The authors sought to investigate whether a patient-specific implantation technique during transcatheter aortic valve replacement (TAVR) can result in a safe and reproducible neo-commissural alignment of self-expanding transcatheter heart valves (THVs). Background: To date, little attention has been paid to neo-commissural alignment during TAVR. Methods: A fluoroscopy-based, patient- and valve-specific TAVR implantation technique was applied in 60 patients treated with 3 different self-expanding THV platforms (Evolut R/PRO, Medtronic; ACURATE neo2, Boston Scientific; and Portico, Abbott—20 patients in each group). Post-TAVR cardiac computed tomography was used to assess THV neo-commissural alignment. Results: Considering all 60 patients, ≤mild commissural misalignment (CMA <30°) was obtained in 53 patients (88%) using this modified TAVR implantation technique—in 36 patients (60%), optimal commissural alignment (<15°) was obtained. In 2 patients, cardiac computed tomography revealed severe CMA (>45°) with overlap between the coronary ostia and THV commissures. Using the ACURATE neo2 platform, operators succeeded in avoiding ≥moderate CMA in all 20 cases. When analyzing those cases in which the optimal amount of THV rotation could be assessed and applied before THV expansion (n = 52; 87%), the success rate of TAVR with ≤mild CMA was 98%. No procedure- or valve-related complications occurred in this study cohort. Conclusions: A patient-specific TAVR implantation technique aiming to obtain neo-commissural alignment is feasible and safe, and aides to prevent THV implantations with overlap between the coronary ostia and THV commissures. Optimized TAVR devices and design may further improve the success rate of TAVR with neo-commissural alignment.

AB - Objectives: The authors sought to investigate whether a patient-specific implantation technique during transcatheter aortic valve replacement (TAVR) can result in a safe and reproducible neo-commissural alignment of self-expanding transcatheter heart valves (THVs). Background: To date, little attention has been paid to neo-commissural alignment during TAVR. Methods: A fluoroscopy-based, patient- and valve-specific TAVR implantation technique was applied in 60 patients treated with 3 different self-expanding THV platforms (Evolut R/PRO, Medtronic; ACURATE neo2, Boston Scientific; and Portico, Abbott—20 patients in each group). Post-TAVR cardiac computed tomography was used to assess THV neo-commissural alignment. Results: Considering all 60 patients, ≤mild commissural misalignment (CMA <30°) was obtained in 53 patients (88%) using this modified TAVR implantation technique—in 36 patients (60%), optimal commissural alignment (<15°) was obtained. In 2 patients, cardiac computed tomography revealed severe CMA (>45°) with overlap between the coronary ostia and THV commissures. Using the ACURATE neo2 platform, operators succeeded in avoiding ≥moderate CMA in all 20 cases. When analyzing those cases in which the optimal amount of THV rotation could be assessed and applied before THV expansion (n = 52; 87%), the success rate of TAVR with ≤mild CMA was 98%. No procedure- or valve-related complications occurred in this study cohort. Conclusions: A patient-specific TAVR implantation technique aiming to obtain neo-commissural alignment is feasible and safe, and aides to prevent THV implantations with overlap between the coronary ostia and THV commissures. Optimized TAVR devices and design may further improve the success rate of TAVR with neo-commissural alignment.

KW - cardiac computed tomography

KW - commissural alignment

KW - implantation technique

KW - patient-specific

KW - TAVR

U2 - 10.1016/j.jcin.2021.06.033

DO - 10.1016/j.jcin.2021.06.033

M3 - Journal article

C2 - 34538602

AN - SCOPUS:85115615905

VL - 14

SP - 2097

EP - 2108

JO - J A C C: Cardiovascular Interventions

JF - J A C C: Cardiovascular Interventions

SN - 1936-8798

IS - 19

ER -